Pandita-Gunawardena R, Donaldson D
East Surrey Hospital, Redhill.
J R Soc Health. 1998 Feb;118(1):35-9. doi: 10.1177/146642409811800108.
The importance of regular monitoring of both serum lithium and creatinine levels, together with thyroid function assessment, in a patient taking lithium carbonate therapy for bipolar affective disorder (hypomanic type) is emphasised. In this case it was the gradual rise of serum creatinine that alerted the physician to the onset of insidiously progressive renal impairment. In the absence of any evidence for another aetiology, it was concluded that a possible cause for the renal problem was the lithium therapy itself. By reducing the dosage it was found that serum lithium levels were maintained within the reference range, thus avoiding the potential psychiatric consequences of high concentrations--which could well have occurred had the former dosage been continued during the period of deteriorating renal function. The situation is currently being carefully monitored in case another cause for renal disease, other than that of a side-effect of therapy, emerges at a later date.
强调了在使用碳酸锂治疗双相情感障碍（轻躁狂型）的患者中定期监测血清锂和肌酐水平以及评估甲状腺功能的重要性。在该病例中，血清肌酐的逐渐升高提醒医生隐匿性进行性肾功能损害的发生。在没有任何其他病因证据的情况下，得出肾脏问题的一个可能原因是锂治疗本身的结论。通过减少剂量，发现血清锂水平维持在参考范围内，从而避免了高浓度可能带来的潜在精神后果——如果在肾功能恶化期间继续使用先前的剂量，很可能会出现这种情况。目前正在密切监测病情，以防日后出现除治疗副作用之外的肾脏疾病的其他病因。
